Management of Chronic Kid...

A 22-year-old female presented to the hospital with stage V Chronic Kidney Disease (CKD) before 7 months of pregnancy. She was subjected to hemodialysis initially for 10.5 hours/ week, and later, at 13.5 weeks of gestation, the duration was increased to 14 hours/week. Before pregnancy, her usual dietary intake was characterized by adequate energy intake (112%), excessive protein intake (1.9 g/kg pregestational ideal body weight), and potentially excessive sodium intake (Na intake from foods represented 100% of needs, without considering table salt). Iron intake from diet and supplements was deemed adequate (92% of recommended intake). After becoming pregnant, the patient reported positive lifestyle modifications such as reduced sweetened carbonated beverage intake, minimum salt use, and eating 3 meals/day with one meal at home. However, high-energy-density foods were consistently consumed (fried foods, etc.), and her diet also included daily fluid intake, including water, fruit juice, and lemon tea, and she also consumed sweetened carbonated beverages (4 times/week).  The patient was on several nutritional supplements, such as folic acid (5 mg/day), calcium (300 mg/day), and vitamin D3 (200 IU/day). Further Anthropometric measurements indicated that she was overweight before pregnancy (pregestational body mass index- 27.08) and gained adequate weight during the first visit of pregnancy (1.2 kg) for gestational age. During hemodialysis sessions, the patient had a diuresis of 1.8 L and was prescribed erythropoietin [4,000 IU/ receiving hemodialysis (HD)] and elemental iron supplementation (100 mg/HD). Additionally, a biochemical data study was performed at week 10.5 during pregnancy, which revealed proteinuria (1,036 mg/24-h urine), thus exhibiting unfavorable food choices in the patient.